Medical use of finererone in patients with diabetes mellitus and chronic kidney disease

Abstract

Chronic hyperglycemia is one of the factors that contributes significantly to the complications associated with diabetes mellitus. Excess glucose causes an imbalance in cellular oxidation/reduction reactions, as well as systemic inflammation and inflammation in the renal parenchyma, playing a critical role in the pathogenesis of diabetic kidney disease, which today is the main reason for dialysis (hemodialysis/peritoneal) in the world. The pathogenesis of the disease is a difficult process to understand and is integrated with other organic and systematic factors; despite the different mechanisms involved in diabetes mellitus-related kidney damage, the biochemical and cellular mechanisms involving the oxidative and inflammatory pathways are widely recognized by science. There is evidence that the persistent state of hyperglycemia triggers oxidative stress and inflammation mediated by deregulated metabolic pathways, in a cycle that repeats itself, promoting the progression of cell damage and kidney disease. Chronic kidney disease (CKD) is an extremely serious condition that is often underdiagnosed. It is one of the most frequent and serious complications of diabetes. More than 40% of patients with type 2 diabetes mellitus develop CKD. Despite the existence of therapies recommended by the guidelines, patients with CKD and type 2 diabetes have a high risk of CKD progression and cardiovascular events with unfavorable outcomes. It is estimated that CKD affects more than 160 million people with diabetes worldwide. Chronic kidney disease resulting from type 2 diabetes is one of the main causes of advanced kidney disease, requiring dialysis or kidney transplantation. For these reasons, science has set itself the goal of conducting serious and impactful studies into the evolution of kidney disease, in which the key points are the use of drugs aimed at reducing the severity and the rapid natural history of the disease, which as a rule evolves into outcomes that are not always favorable to the patient. Many scientific studies have advanced in this century with an important impact on medicine, such as the FIGARO-DKD and FIDELIO-DKD studies, which seriously analyzes the impact and relevance of the use of mineralcorticoid receptor antagonists, specifically finerenone, in patients with type 2 diabetes mellitus and chronic kidney disease.